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Updated: Nov 12, 2025
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Kidney transplantation from donation after circulatory death using abdominal normothermic oxygenated circulation: are
Margarida Manso1,2, Luís Pacheco-Figueiredo3,4, Tiago Antunes-Lopes3,5
1Urology Department, Centro Hospitalar Universitário São João, Alameda Prof. HernaniMonteiro, 4200-319, Porto, Portugal. manso.margarida@gmail.com.
Insights
Kidney transplantation from donation after circulatory death (DCD) donors using abdominal normothermic oxygenated circulation (ANOR) support shows promising outcomes. This method helps increase the kidney transplant pool, despite challenges like delayed graft function.
Area of Science:
- Nephrology
- Transplantation Surgery
- Organ Donation
Background:
- Rising demand for kidney transplants necessitates exploring alternative donor sources.
- Donation after circulatory death (DCD) offers a potential solution to expand the donor pool.
- Abdominal normothermic oxygenated circulation (ANOR) is an emerging support strategy for DCD kidneys.
Purpose of the Study:
- To evaluate the outcomes of kidney transplantation utilizing DCD donors supported by ANOR.
- To assess graft function and surgical complication rates in this DCD kidney transplant cohort.
Main Methods:
- Prospective observational study of 58 kidney transplants from uncontrolled DCD donors after ANOR support (Jan 2016 - Dec 2018).
- Assessment of graft function (serum creatinine) and surgical complications.
- Analysis of donor/recipient factors (gender, age) and ischemia times (warm, cold) as outcome determinants.
Main Results:
- Median follow-up of 31.2 months.
- Delayed graft function (DGF) observed in 80%; serum creatinine at 1 year was 1.33 mg/dL.
- Primary non-function (PNF) in 5.2%; male donors linked to lower DGF (OR 0.21).
- Higher donor age predicted poorer graft function (β = -0.88).
- Surgical complications in 31% (mainly vascular); warm ischemia >60 min increased risk (OR 11.33).
Conclusions:
- Kidney transplantation from DCD donors with ANOR support is a viable strategy.
- This approach can help bridge the gap between transplant waiting lists and organ availability.
- Careful consideration of donor factors and ischemia times is crucial for optimizing outcomes.
Purpose:
To increase the pool of kidneys available for transplantation, a renewed interest in donation after circulatory death (DCD) has emerged. This study aims to determine the outcomes of kidney transplantation from DCD after abdominal normothermic oxygenated circulation (ANOR) support.
Methods:
From January 2016 to December 2018, 58 kidneys were implanted from uncontrolled DCD after ANOR support. We performed an observational prospective study, assessing graft function and cumulative incidence of surgical complications. A descriptive analysis was conducted. Potential determinants of the outcomes were evaluated, including donor and receptor gender and age, and warm and cold ischemia times. Regression coefficients (β) and odds ratio (OR) were calculated with 95% confidence intervals. A p-value < 0.05 was considered statistically significant. Statistical analysis was accomplished using Stata 11.0 software.
Results:
The median follow-up time was 31.2 months. Delayed graft function (DGF) was evident in 80%, with a mean Cr one month after transplantation of 1.81 mg/dL and 1.33 mg/dL after one year. Primary non-function (PNF) occurred in 5.2% of cases. Male donors were associated with a lower DGF (OR = 0.21, p < 0.05), and a higher donor age was a predictor of poorer graft function at one year (β = - 0.88, p < 0.05). Surgical complications occurred in 31% patients, predominantly vascular. Warm ischemia time superior to 60 min correlated with a higher risk of surgical complications (OR = 11.33, p < 0.05).
Conclusion:
Kidney transplantation from DCD is a valuable option, allowing an improvement in the balance between patients waiting for a transplant and the available kidneys.
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